Provider Demographics
NPI:1003215310
Name:THERAPY WITHOUT WALLS
Entity Type:Organization
Organization Name:THERAPY WITHOUT WALLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GINTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:608-843-3229
Mailing Address - Street 1:348 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:REEDSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53959-1940
Mailing Address - Country:US
Mailing Address - Phone:608-843-3229
Mailing Address - Fax:608-768-0816
Practice Address - Street 1:348 E MAIN ST
Practice Address - Street 2:
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959-1940
Practice Address - Country:US
Practice Address - Phone:608-843-3229
Practice Address - Fax:608-768-0816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)